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PubMed2001

Hemochromatosis gene variants in three different ethnic populations: effects of admixture for screening programs.

Genetic testing for hemochromatosis may have important implications for diagnosis and screening of the disease. However, the relative importance of mutations in the gene for hereditary hemochromatosis, HFE, may vary among populations, when the mutant allele frequencies and their penetrance in a particular genetic and environmental background are taken into account. We present data on the allele and genotype frequencies and population structure of two HFE genetic variants in three different ethnic groups from a highly mixed urban population (São Paulo, Brazil). Allele frequencies for both the C282Y and H63D HFE mutations showed significant differences among the studied populations (for the C282Y mutation, Euro-Brazilian 3.7%, admixed 0.7%, Afro-Brazilian 0.5%; and for the H63D mutation, Euro-Brazilian 20.3%, admixed 13.0%, Afro-Brazilian 6.4). The data substantiate a European origin for these mutations. Furthermore, they provide a basis for a more rational strategic planning of population screening programs for the disease.

Analysis of Variance↗

PubMed1991

A breast cancer screening program in a community hospital.

Breast cancer screening continues to be underutilized in the United States. The National Cancer Institute has set a goal of increasing screening by the year 2000. The American Cancer Society wants to identify programs that target asymptomatic women and economically disadvantaged women. The purpose of this study was to develop, implement and evaluate a comprehensive breast cancer screening program for women in a community setting. One case of infiltrating ductal carcinoma was detected from the 144 women who participated in the study. Following the educational component, the post test demonstrated a significant increase (p less than 0.01) in the women's awareness of breast cancer. Additionally, 100% of the women were able to demonstrate breast self examination to an oncology nurse after the educational component of the study. The majority of the women who participated were not economically disadvantaged which sheds new light on the scope of the problem of taking care of the unmet cancer needs of the disadvantaged through outreach programs. However 27% of the women had a household income less than $10,000 with 19% of the women having no insurance and 7% having Medicare/Medicaid. The results of this study could help future programs in bringing breast cancer screening to women in the community setting.

Adult↗

PubMed2006

Financing state newborn screening programs: sources and uses of funds.

BACKGROUND: Financing for newborn screening is different from virtually all other public health programs. All except 5 screening programs collect fees as the primary source of program funding. A fee-based approach to financing newborn screening has been adopted by most states, to ensure consistent funding for this critical public health activity. METHODS: Two types of data are reported here, ie, primary data from a survey of 37 state public health agencies and findings from exploratory case studies from 7 states. RESULTS: Most of the programs that participated in this survey (73%) reported that their newborn screening funding increased between 2002 and 2005, typically through increased fees and to a lesser extent through Medicaid, Title V Maternal and Child Health Services Block Grant, and state general revenue funding. All of the responding states that collect fees (n = 31) use such funds to support laboratory expenses, and most (70%) finance short-term follow-up services and program management. Nearly one half (47%) finance longer-term follow-up services, case management, or family support beyond diagnosis. Other states (43%) finance genetic or nutritional counseling and formula foods or treatment. CONCLUSIONS: Regardless of the source of funds, the available evidence indicates that states are committed to maintaining their programs and securing the necessary financing for the initial screening through diagnosis. Use of federal funding is currently limited; however, pressure to provide dedicated federal funding would likely increase if national recommendations for a uniform newborn screening panel were issued.

Data Collection↗

PubMedDate not supplied

[Characteristics of transient evoked otoacoustic emissions in newborn hearing screening program].

BACKGROUND: Otoacoustic emissions (OAE) are considered the main instrument of the Newborn Hearing Screening Program (NHSP). AIM: To analyze the OAE of newborns evaluated in the NHSP. METHOD: Transient evoked OAE recordings were captured in 1000 infants. The data were analyzed using the analysis of multivaried variance (Manova). RESULTS: Reference tables were calculated for the over all OAE levels and for frequency bands, according to gender and ear. The duration of the exam in the nursery was shorter than in the clinic. CONCLUSION: The level of the OAE was influenced by gender and ear, except for 0,7kHz. However, there were no observed differences between neonates without and with auditory risk.

Brazil↗

PubMed1995

Who comes to a voluntary depression screening program?

OBJECTIVE: The purpose of this study was to describe who comes to a voluntary depression screening program by analyzing findings from the 1992 National Depression Screening Day. METHOD: Survey results from 5,367 adult volunteers at 345 facilities were analyzed. The authors examined the prevalence of depression detected at the screening test and sociodemographic characteristics and treatment history of the respondents. They also estimated the percentage of these individuals who would actually have a diagnosis of major depression (positive predictive value). The main assessment measure was the Zung Self-Rating Depression Scale. RESULTS: Of all participants, 76.6% (N = 4,109) had at least minimal depressive symptoms (score of at least 50 on the Zung depression scale), 53.3% (N = 2,859) had at least moderate symptoms (score of at least 60), and 22.6% (N = 1,214) had severe symptoms (score of at least 70). Few of the depressed respondents were currently in treatment for a mental health problem. The positive predictive value of a screening test diagnosis of depression was between 92.5% and 95.5% when a cutoff score of 60 was used to indicate depression and between 88.7% and 92.3% when a cutoff score of 50 was used. CONCLUSIONS: Voluntary screening tests, as exemplified by results from the National Depression Screening Day, provide a good opportunity for identifying previously unidentified and untreated individuals with depression.

Adolescent↗

PubMed2005

Cervical cancer screening program of Paraná: cytohistological correlation results after five years.

Since its inception in November 1997, the Cervical Cancer Screening Program of Paraná (CCSPP), Brazil, has resulted in the cytological screening of 2,244,158 women, the coverage of the female population increasing from 43% to 86%. One thousand six hundred one cases screened by cytology, submitted to colposcopy, and subjected to treatment were selected. Cytopathological results were compared with those obtained on the basis of histological analyses of the loop electrical excision procedure specimens, and were subjected to statistical analyses. The data obtained were then compared with cytohistological correlation results from the first year of the program. Considering the exact correlation between cytological and histological diagnoses, the correlation index increased from 53.34% in the first year to 67.3% at the end of 5 yr of the program. Variations that occurred in each diagnostic category are discussed. This study demonstrates a significant improvement in the concordance between cytological and histological results for the 5-yr period compared with the first year of the CCSPP.

Adolescent↗

PubMed2004

Much gained by integrating contact tracing and vaccination in the hepatitis B antenatal screening program in Amsterdam, 1992-1999.

BACKGROUND/AIMS: Hepatitis B control in Europe concentrates on antenatal screening to reduce vertical transmission. To reduce horizontal transmission and the pool of infectious individuals, the Municipal Health Service of Amsterdam integrated tracing and immunising of contacts in the antenatal screening program. METHODS: An eight year (1992-1999) descriptive study of this public health program, where contacts are tested for serological markers of previous infection, and vaccination is offered to susceptible contacts. Chronically infected contacts are counselled and referred for treatment if justified. RESULTS: For 738 newly identified women testing positive for the hepatitis B surface antigen, 1219 contacts were reported; 1100 (90.4%) contacts participated, 476 (43%) had serological markers of previous infection, of whom 119 (25%) were infectious. Of 603 eligible contacts, 568 (94%) completed the vaccination series. Country of origin was an independent predictor of contact participation and compliance with completion of the vaccination series. Postvaccination titres for antibodies against the surface antigen were below 10 IU/L in 4.5% of contacts under 30, in 12.2% of those over 30. CONCLUSIONS: Tracing and immunising susceptible contacts of women screened as HBsAg-positive, should be an integral component of any country's HBV control program.

Contact Tracing↗

PubMed2006

A passive smoking screening program for children.

BACKGROUND: There has been no report to date on mass screening of passive smoking in children using biomarkers. METHOD: To identify children exposed to actual environmental tobacco smoke (ETS), 261 children were divided into the following 3 groups: (A) both parents smoke; (B) one parent smokes; and (C) no parent smokes. Child urinary cotinine measurement and a parent questionnaire were obtained. RESULTS: Urinary cotinine was positive (>10 ng/ml) in 92 (35.2%) of the 261 children. Of the 92 children, 29 were classified into group A, 47 into group B, and 16 into group C. The percentages of children who tested positive for urinary cotinine in groups A, B, and C were 56.9%, 31.1%, and 27.1%, respectively. However, in group B, the percentage of children who tested positive for urinary cotinine was significantly higher if only the mother smoked (47.1%) than if only the father smoked (29.1%) (P<0.05). The mean+SD urinary cotinine level in group A was 12.9+/-6.5 ng/ml, and that in group B was 10.4+/-3.8 ng/ml if the mother smoked and 5.4+/-2.6 ng/ml if the father smoked. CONCLUSIONS: This smoking screening program may be useful in identifying children with actual ETS exposure and motivating their parents to either quit smoking or modify their smoking behavior around children.

Adult↗

PubMed2007

Results of the national pilot screening program for venous disease by the American Venous Forum.

OBJECTIVE: This report describes the pilot of a free comprehensive national screening program for venous disease. METHODS: The screening process consisted of a venous thromboembolism (VTE) risk assessment, abbreviated duplex examination for venous obstruction and reflux, inspection for signs of chronic venous insufficiency (CVI), and an exit interview. Physicians coordinating the screenings were members of the American Venous Forum. RESULTS: Seventeen institutions screened 476 people (mean, 28 per site; range, 6 to 71). Mean age was 60 years (range, 40 to 91 years), with 78% women and 68% with a body mass index of > or =25. If placed in a situation conducive for VTE, 22 participants (5%) were low risk, 87 (18%) were moderate risk, 186 (39%) were high risk, and 179 (38%) were at very high risk. In 26 people (6%), one or more segments had venous obstruction, and 190 (40%) had one or more segments of venous reflux in the lower extremities. Varicose veins were present in 32%, edema without skin changes in 11%, skin changes attributable to venous disease in 8%, and healed or active venous stasis ulcer in 1.3% (CEAP classification 2, 3, 4, 5, and 6, respectively). Increasing age and increasing deep venous thrombosis risk score significantly correlated with increasing clinical classification, r = 0.09, P = .04, and r = 0.16, P = .0004, respectively. Those participants with reflux in one or more segments were significantly more likely to have a higher clinical classification compared with those with no reflux (P = .0001). CONCLUSION: The first comprehensive national screening for venous disease was performed. Participants were informed of their risk for VTE if placed in a situation conducive to VTE, screened for evidence of obstruction, reflux, and CVI, and empowered to share their results with their primary care provider.

Adult↗

PubMed1998

A multiplex ARMS test for 10 cystic fibrosis (CF) mutations: evaluation in a prenatal CF screening program.

In Maine, prenatal screening for cystic fibrosis (CF) is offered through primary care providers. Cheekbrush (buccal) samples are routinely tested for eight mutations by multiplex PCR amplification of five exons, followed by dot-blot hybridization with pooled allele-specific oligonucleotides (ASO). The ASO methodology is widely used and effective, but somewhat time and labor intensive when applied to CF carrier testing or couple-based prenatal screening in the general pregnant population. Amplification Refractory Mutation System (ARMS) is an improvement of the PCR that allows rapid detection of mutations involving single base changes or small deletions/insertions. In this study, two multiplex ARMS reactions are used to test for 10 common CF mutations. Clinical evaluation of the ARMS test includes a retrospective study of 140 banked samples (54 cell line, proficiency testing, and buccal controls; 86 clinical buccal samples) with known CF genotype (57 with CF mutations, 83 no mutation), followed by a prospective trial in which 309 buccal samples are analyzed con-currently using both methods. The success rate of the ARMS test in buccal lysates is comparable to the ASO method; all CF mutations are successfully identified. For testing nonsterile buccal lysates with low DNA concentrations, optimized performance in the ARMS method is obtained using Amplitaq Gold polymerase. The ARMS method developed is easy, rapid (1 day), and avoids the need for ASO probe labeling, dot-blotting and autoradiography. This study provides further evidence that ARMS methodology is suitable for clinical CF mutation analysis.

Cheek↗

PubMed1999

Going the distance: the influence of practice location on the Ontario Maternal Serum Screening Program.

BACKGROUND: The Ontario Maternal Serum Screening (MSS) Program was introduced by the Ontario Ministry of Health as a province-wide pilot project in 1993. The objective of this study was to determine the influence of practice location on Ontario health care providers' use of and opinions regarding MSS, access to follow-up services and recommendations about the program. METHODS: A questionnaire was mailed to a random sample of 2000 family physicians, all 565 obstetricians and all 62 registered midwives in Ontario between November 1994 and March 1995. RESULTS: Among providers who were eligible (those providing antenatal care or attending births) the response rates were 91.4% (778/851), 76.0% (273/359) and 78.0% (46/59) respectively. Fewer respondents in the Northwest region (71.4%) and in rural areas (81.9%) stated that they routinely offer MSS to all pregnant women in their practices compared with respondents in other regions (84.4%-91.5%) and urban centres (90.1%). Fewer respondents in the northern regions (Northeast 49.2%, Northwest 25.0%) than in the Central East region (includes Toronto) (76.6%) felt that follow-up services were readily available. Respondents in the northern regions had less favourable opinions of MSS than those in the other regions in terms of its complexity, cost, the time involved in counselling and the high false-positive rate. More respondents in the Central East region (64.6%) and in urban centres (52.9%) recommended not changing the MSS program than did those in the Northwest (7.1%) and rural areas (39.8%). After provider characteristics were controlled for in a logistic regression analysis, practice location was not the most important factor. Instead, the model showed that respondents who cared for 50 or more pregnant women in the previous year were more likely to offer MSS routinely (OR 2.00, 95% CI 1.21-3.27) and that those who felt that patient characteristics affect the offering of MSS (OR 0.42, 95% CI 0.26-0.67) or that follow-up services were not readily available (OR 0.33, 95% CI 0.20-0.55) were less likely to offer it. INTERPRETATION: Health care providers in northern and rural Ontario were less likely to offer MSS routinely than those in other regions and were more likely to recommend changing or eliminating the program. Providers' concerns about the social and cultural sensitivity of MSS and the availability of follow-up services affected use.

Abnormalities, Multiple↗

PubMed1980

A computerized follow-up system for hemoccult screening programs.

Prior to the development of the CSFS, the logistics of hemoccult stool screening required many hours of clerical and secretarial time. In order to conduct multiple county, multiple location screening programs, the CSFS has been developed as a specialized application of the Roswell Park Management System (RPMIS). CSFS uses the RPMIS for formatted video data entry and editing and for report production. This system makes it possible to generate forms and letters for all patients and physicians by typing a single command. The computer output also includes cross checks for errors and updating reminders. Using non-computerized methods, 363 patients required 157 hours. The most recent 74 patients screened required less than two hours. This significant streamlining of the workload will allow for more effective utilization of this currently available screening test.

Colonic Neoplasms↗

PubMed1989

Comparison of participants and nonparticipants in a work site cancer awareness and screening program.

In 1985, Pennzoil Company offered a company-paid cancer awareness and screening program focusing on breast and colorectal cancers for its employees. Following a lecture/slide presentation, employees filled out a risk assessment questionnaire. Those at risk for breast and/or colorectal cancers were invited for consultation, mammography, and/or short colonoscopy. Overall completion rates were 49% for mammography, 20% for the fecal occult blood test, and 31% for short colon oscopy, but these rates varied by risk status. Moreover, the same demographic and risk factors were not consistently associated with completion of the same screening procedure across risk groups. Based on these findings, we suggest that different interventions may need to be developed depending on the risk characteristics of subgroups within the target population.

Adult↗

PubMed1999

Outcome of a screening program for vancomycin-resistant enterococci in a hospital in Victoria.

OBJECTIVE: To screen for faecal colonisation with vancomycin-resistant enterococci (VRE) among potentially at-risk patients. DESIGN: Infection control screening program. SETTING: Monash Medical Centre (a tertiary care hospital), Melbourne, Victoria, in the seven months from June 1997. PATIENTS: Patients in the Renal, Oncology and Intensive Care (ICU) Units. MAIN OUTCOME MEASURES: Presence of VRE in a rectal swab or faecal specimen taken at admission and at regular intervals during inpatient stay; presence of vancomycin-resistance genes (vanA, vanB and vanC) assessed by polymerase chain reaction (PCR); genetic clonality of isolates assessed by pulsed-field gel electrophoresis (PFGE). RESULTS: 574 patients (356 renal, 134 ICU and 84 oncology) were screened; 12 were colonised with VRE--nine renal inpatients, two having peritoneal dialysis or incentre haemodialysis, and one ICU patient. Nine isolates were Enterococcus faecalis (seven positive for vanB and two negative for all three resistance genes) and three were Enterococcus faecium (all positive for vanB). Eight were high-level gentamicin resistant. PFGE suggested genetic clonality between the index isolate and five other isolates from renal patients. No specific clinical practice was associated with VRE colonisation. Attempts to clear rectal carriage with oral ampicillin/amoxycillin or bacitracin were of limited success. Although antibiotic prescribing in the Renal Unit was generally consistent with defined protocols, use of vancomycin and third-generation cephalosporins has been further restricted. CONCLUSIONS: Renal inpatients in our institution appear most at risk of VRE colonisation (4.6% overall) and therefore of VRE infection. Routine screening, especially of potentially high-risk patients, should be considered in major Australian hospitals.

Adult↗

PubMed1997

Factors related to non-attendance in a population based melanoma screening program.

A total of 127 non-attenders in a population-based melanoma screening program, 58 women and 69 men, were asked in a telephone interview about reasons for non-attendance. Of those, 105 also completed a mailed questionnaire, measuring perceived susceptibility to and knowledge about melanoma. During the same period, attenders (n = 286) at the screening clinic completed the same questionnaire. The most commonly reported reasons for non-attendance were 'I forgot about it', 'lack of time' and 'no need for examination'. A majority of non-attenders held a positive attitude towards preventive programs in general and to the present invitation. Most of the improvements suggested by the non-attenders were strategies to reduce practical barriers. Non-attenders scored lower than attenders on perceived susceptibility. High and equal levels of knowledge about melanoma were found among attenders and non-attenders. Men were more likely to be non-attenders. Higher perceived susceptibility and a higher level of knowledge about melanoma were found among women as compared to men. The results suggests that there is potential to increase attendance in future melanoma programs by reducing practical barriers.

Adult↗

PubMed1992

The Tokyo Metropolitan Home Vision Screening Program for amblyopia in 3-year-old children.

In August 1989, the Tokyo Metropolitan Government officially began a vision screening program for children aged 3 years 1 month. A 1988 pilot study of 1,303 children this age disclosed five cases (0.38%) of amblyopia. The home vision test, which uses picture cards of familiar figures, proved to be an efficient and inexpensive method of screening when incorporated into the existing health-check program for 3-year-old children. In the initial eight months of the program, 21,906 children were screened. Of these, 419 children (1.9%) were referred to an ophthalmologist for follow-up, and amblyopia was detected in 41 children (0.19%).

Amblyopia↗

PubMed1999

A nursing screening program for diabetes in northern New Mexico.

This paper presents the results of a community screening program conducted by nurses in northern New Mexico. Seven hundred and ninety-nine persons were screened for diabetes following American Diabetes Association guidelines. Screening procedures included having participants complete a questionnaire and testing them for capillary blood glucose levels. Initial results found a 5.7% positive screening rate. A large proportion of those who tested positive (80%) were unavailable for follow-up procedures.

Adolescent↗

PubMed1990

Colorectal adenomas in the Lynch syndromes. Results of a colonoscopy screening program.

Forty-four asymptomatic putative Lynch syndrome patients participated in a colonoscopy screening program. There were 18 men and 26 women; mean age was 44 yr. Thirty percent of Lynch syndrome patients had at least one adenoma; 20% had multiple adenomas. In 18% of the patients, adenomas were discovered proximal to the splenic flexure. In a reference group of 88 age- and sex-matched patients, 11% had adenomas, 4% had multiple adenomas, and 1% had right-sided adenomas. Twenty-one Lynch syndrome patients had follow-up colonoscopies. Of 7 patients with adenomas on initial examinations, 6 had adenomas at follow-up. Of 14 patients with negative initial examination results, 3 had adenomas at follow-up. The prevalence of adenomas in the Lynch syndromes is greater than in an unselected reference group. The adenomas are more proximally located, corresponding to the site of cancer distribution in the Lynch syndromes. A high rate of synchronous and metachronous lesions is found. Our findings support the hypothesis that adenomatous changes are the premalignant lesion in the Lynch syndromes. We also found evidence of heterogeneity among Lynch syndrome families in adenoma incidence.

Adenoma↗